Knee

Knee Conditions

Posterior Cruciate Ligament (PCL) Injury

The four ligaments that stabilize the knee are:

  • The anterior cruciate
  • The posterior cruciate(PCL)
  • the lateral ligaments
  • medial collateral ligaments

The PCL has been described as one of the main stabilizers of the knee. It is broader and stronger than the ACL. It connects the femur (thigh bone) to the tibia (shin bone). Its function is to prevent the posterior translation of the tibia relative to the femur.

It has been reported that there is only a 2% incidence of isolated PCL tears. PCL injury commonly occurs in sports such as football, soccer, basketball, and skiing. A forceful hyperextention of the knee or a direct blow just below the knee cap will disrupt the PCL and cause knee pain and PCL Injury. For example, the football player who is tackled with a direct hit to the knee will hyperextend the limb and sustain a PCL Injury. The basketball player who lands on the court directly on a bent knee will tear his PCL resulting in knee pain. A thorough evaluation by a sports medicine specialist is needed to assess the extent of the ligament injury and the appropriate treatment options. Both examples frequently lead to knee pain which often requires knee surgery.

Medial Collateral Ligament (MCL) Injury

The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).

The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The medial collateral ligament resists widening of the inside of the joint, or prevents "opening-up" of the knee.

Grade I MCL Tear

This is an incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 2-4 weeks of play.

Grade II MCL Tear

Grade II injuries are also considered incomplete tears of the MCL. These patients may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 4-6 weeks of rest is necessary.

Grade III MCL Tear

A grade III injury is a complete tear of the MCL. Patients have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.

Lateral Collateral Ligament (LCL) Injury

The lateral collateral ligament (LCL) is one of the four knee ligaments. It spans the distance from the end of the femur (thigh bone) to the top of the fibula (thin, outer, lower leg bone) and is on the outside of the knee. The lateral collateral ligament resists widening of the outside of the joint. A lateral collateral ligament injury happens from a direct force from the side of the knee, causing moderate to severe knee pain and ligament injury which often leads to knee surgery. It is much less frequent ligament injury than the medial collateral ligament (MCL) but commonly occurs with other ligament injury to the knee.

Meniscal Tear

The meniscus is a very important shock absorber of the knee made of a very strong substance called fibrocartilage. It protects the cartilage of the joint, keeping it from wearing out and causing early arthritis. A large percentage of our body weight is distributed through the meniscus as we walk, run, and jump. The meniscus adds to the stability of the knee joint by helping the shape of the femur or thigh bone conform to the tibia or leg bone. The meniscus also plays a role in the nourishment of the joint cartilage that covers the bones in the joint.

Symptoms

An acute meniscal tear may be heard as a "pop" and felt as a tear or rip in the knee. Many are followed within a few minutes to hours by swelling of the knee as a result of blood accumulation. Some do not result in much swelling and some present themselves in a less acute fashion. Patients with meniscal tears often describe a popping or catching in their knee. Some actually can feel something out of place. In the most dramatic situations the knee will actually lock, preventing the patient from fully extending or straightening the knee -- or occasionally from flexing or bending it. The pain or discomfort is usually along the joint line or where the femur and tibia bone come together. It often starts out relatively painful; then with time, much (if not all) of the pain disappears except with certain activities. Some patients will have the tear become asymptomatic (no symptoms) for a time, especially if their activity level decreases significantly.

Causes

Several events can cause the meniscus to become damaged. It can tear or rip from force, pinching it between the femur and the tibia. Most frequently this is a twisting-type force and is relatively common in sports-related knee injuries. Occasionally it is associated with a ligament rupture. It does not always require a major fall or twist to cause a meniscal tear. Some occur with nothing more than getting up from a squatting position. Certain meniscal tears occur gradually over a long period of time. In older patients these may represent so-called degenerative meniscal tears and may not be symptomatic. The location of the tear within the meniscus may determine the type of treatment which is most appropriate.

Knee Arthritis

Arthritis simply means an inflammation of a joint causing pain, swelling, stiffness, instability and often deformity. Severe arthritis interferes with a person’s activities and limits his or her lifestyle.

Osteoarthritis or Degenerative Joint Disease is the most common type of arthritis. Osteoarthritis is also known as "wear and tear arthritis" since the cartilage simply wears out. When cartilage wears away, bone rubs on bone causing severe pain and disability. The most frequent reason for osteoarthritis is genetic, since the durability of each individual’s cartilage is based on genetics. If your parents have arthritis, you may also get it.

Trauma can also lead to osteoarthritis. A bad fall or blow to the knee can injure the joint. If the injury does not heal properly, extra force may be placed on the joint, which over time can cause the cartilage to wear away.

Inflammatory Arthritis Swelling and heat (inflammation) of the joint lining causes a release of enzymes which soften and eventually destroy the cartilage. Rheumatoid arthritis, Lupus and psoriatic arthritis are inflammatory in nature..

Cartilage Injuries
Injury to the knee can cause damage to the articular lining cartilage in the knee joint, or sometimes to both the cartilage and the bone.

If the injury is restricted to the cartilage, it will not show up in a plain X-ray; it may be noted on an MRI. An arthroscopy (using a special instrument to look inside the joint) can thoroughly identify it.

Detached Cartilage of Bone in the Knee Joint

If a piece of cartilage or bone has become detached in the knee and the injury is not treated immediately, the loose part can 'swim around' in the joint. This means that it may occasionally get stuck, causing pain and a feeling that the knee is locked. The knee may also click and swell up. Such a condition is called a loose body in the knee.

As cartilage does not show up on an X-ray, the loose body will only be visible if it consists of bone.

When is it Time to Think About Surgery?About the SurgeryPreparing for SurgeryWhat to Expect After SurgeryComplications and Risks of SurgeryRecovery PeriodTreating and Preventing InfectionPrintable PDF

You may need total knee replacement surgery if you are experiencing pain, stiffness or loss of motion in your knee joint. These symptoms may be caused by degenerative arthritis (osteoarthritis), rheumatoid arthritis or injured knee cartilage. When pain interferes with daily activities such as walking, climbing stairs or getting out of a chair, it’s usually time to consider having surgery.

Total knee replacement involves removing diseased cartilage on your knee surfaces and replacing it with smooth artificial surfaces. This is done by removing your thigh (femur) bone surface and lower leg (tibia) bone surface and replacing it with a metal and plastic implant. A plastic “button” piece is also implanted under your kneecap surface. These three components make up your new knee replacement surfaces.

You should be examined by your family doctor to ensure you are healthy enough for the planned surgery. You will be encouraged to stop smoking before surgery to prevent lung complications and promote healing after surgery. Pre-admission testing (lab work and EKG) and attendance at a “joint camp” will also be scheduled to further help you prepare for surgery. Anti-inflammatory medications, aspirin, and blood thinning medications should be discontinued one week before your surgery. These medications affect your blood clotting factors and could increase your risk of blood loss during surgery.

You will awake in the recovery room after surgery with an IV for antibiotics and fluid replacement that will be continued for 24 hours. You may receive medication through an IV-regulated pump to control your pain.

Physical therapy will begin the day after your surgery and you will be instructed on how to walk with the use of crutches or a walker. You may also be allowed to bear weight on the affected knee.

You may be given a prescription for a blood thinner such as Coumadin, Xarelto, Lovenox, or Aspirin to take after surgery, in order to prevent blood clots during the healing process.

Blood clots: You are encouraged to get up and move frequently as well as take your prescription blood thinner OR aspirin to help prevent clotting. Symptoms of clotting include pain, swelling or redness of your calf or thigh, and shortness of breath. Call the office immediately if you develop any of these symptoms.

Infection: Infection is rare, but can occur following surgery. You are at a higher risk for infection if you have diabetes, rheumatoid arthritis, chronic liver or kidney disease, or if you are taking steroids. Symptoms include fever or chills, drainage, redness, a foul smell or increased pain at the surgical site. Call the office immediately if any of these symptoms occur.

Blood loss: It is possible that you will need a blood transfusion following surgery. Your doctor will evaluate you daily to determine if there is a need for a transfusion.

Nerve damage: As your doctor makes his knee incision, many small skin nerves will have to regenerate. Some numbness may occur on the outside of your knee incision. This numb feeling may take months to diminish, or it may be permanent.

Anesthesia complications: Respiratory failure, shock, cardiac arrest, and death are always possible during surgery. Patients with long-term kidney, heart, liver, or lung disease are at a higher risk.

Pneumonia: Lung congestion is possible while you are recovering from surgery and are not as active. Coughing and deep breathing are encouraged to help you expand your lungs and clear any congestion.

Constipation: Bowel movements slow down with less activity and the use of pain medications. You will be encouraged to use stool softeners after you are discharged to promote regular bowel movements and prevent constipation.

Urinary tract infection: Infection to your urinary tract can occur after having surgery. Symptoms include burning and frequent urination, as well as blood in your urine. Fever and weakness may also occur. Report any of these signs to your doctor. This type of infection is a major source of joint infection and should be treated with antibiotics quickly.

Implant malfunction: There is a slight risk that the prosthesis will fail to attach to your bone causing loosening of the implant.

The average recovery period for knee replacement surgery is 2-3 months. Most patients are back to work in 2 months if their job is sedentary, and 3 months if they have a labor-intensive job. Exercise such as running, skiing, or contact sports are discouraged following knee replacement surgery. Activities like swimming, walking and biking are encouraged to promote knee strength and overall fitness.

Notify your family doctor if you develop any suspected infection so you can be placed on an antibiotic to prevent the spread of infection to your knee joint. Infections such as ear infections, ingrown toenails, bladder infections, sinus infections, and sore throats should be reported immediately. Make sure all your doctors know you have had a joint replacement so you can be pre-medicated with an antibiotic before any dental work, or bladder/bowel surgery.

Knee Specialists


Dr. Dirk A. Bakker
Dr. Dirk A. Bakker
Dr. Rick A. Baszler
Dr. Rick A. Baszler
Dr. Phillip J. Dabrowski
Dr. Phillip J. Dabrowski
Dr. Daniel J. Fett
Dr. Daniel J. Fett
Dr. Yousif I. Hamati
Dr. Yousif I. Hamati
Dr. Martin M. Pallante
Dr. Martin M. Pallante
Dr. Aaron D. Potts
Dr. Aaron D. Potts
Dr. Jeffrey D. Recknagel
Dr. Jeffrey D. Recknagel
Dr. James R. Ringler
Dr. James R. Ringler
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